143. Management of Compression Neuropathies Associated with Vascular Malformations

BACKGROUND: Vascular malformations (VMs) are a collection of structural abnormalities in blood vessels resulting result from abnormal overgrowth of vascular tissue. They can lead to infection, disfigurement, decreased mobility and pain. An often-overlooked contributor to the VM pain complex is compressive neuropathy, wherein VM invade or exert a direct mass effect on nearby structures, including nerves, causing pain, numbness, and/or functional impairment. If conservative therapy or minimally invasive strategies fail, surgical resection is considered. However, VMs’ thin walls and, tendency to infiltrate and/or recur frequently makes resection difficult or impossible, leaving patients suffering from their symptoms. It is our experience that VM-related nerve compression is amenable to surgical intervention in the form of nerve decompression, even when VM resection is not feasible. We present a series of patients with VMs causing symptomatic nerve compression that were successfully treated with nerve decompression, with or without VM resection. METHODS: Retrospective chart review of patient undergoing nerve decompression surgery for symptoms of peripheral nerve compression (pain and/or motor/sensory dysfunction) attributable to a nearby VM (confirmed on pre-operative magnetic resonance imaging), with or without VM resection. All patients were treated by a single surgeon. RESULTS: Six patients with VMs adjacent to major peripheral nerves at known points of anatomic compression In five cases, the VMs were highly infiltrative and could not be feasibly resected without substantial risk of morbidity. Therefore, these patients underwent isolated nerve decompression, while one patient’s VM was suitable for both resection and decompression. The majority of were female (N = 4) and ages ranged from 21-52 (mean: 31.2 years). Five of six patients had undergone previous surgical intervention (resection or sclerotherapy) without clinical improvement in radiculopathy. Following decompression (with or without resection), all patients demonstrated improvement of their pain and motor/sensory dysfunction. CONCLUSIONS: VM patients with nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is deemed too high risk for resection. Even when ‘unresectable’, patients may still benefit from surgery in the form of nerve decompression.